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5 West: Sky’s the limit! August 25, 2006

Posted by 5 Wester in General Announcements.
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There’s nothing like the thrill and excitement of flying to get your adrenalin pumping.

If you’ve flown before, you probably know what I mean. The sudden acceleration you experience when the airplane is given the “cleared for takeoff” by the control tower… the sensation of being pressed down in your seat while it finally lifts off the ground and does it’s safety climb until you reach 35,000 feet.

You gaze out the window and see everything shrink as you get to the top of the world. Cars and trucks look like ants crawling freeways that stretch for miles on end. Homes and high rise buildings look like game pieces on “Monopoly”. You suddenly get a bird’s eyeview and you start seeing things you’ve never seen before, or at least you never knew that they exist, until you get to a higher vantage point. All of a sudden, the world seems to reveal itself in a whole new way, and then you get the “bigger picture” of things. You see things in a different perspective and your horizon literally broadens. You’re attitude change and you suddenly find yourself “open” to a whole new world of possibilities… and all of a sudden, you see the world in a different light, and you know you’ve grown from that experience.

It’s been more than 1.5 years since I boarded the plane to come to MMC for the first time, and let me tell you, it’s quite an experience. Time flies when you’re having fun, and for the last year and a half, it sure has been for me. I remember the first few months starting out (and I’m sure most of you do), the sheer agony of adjusting to a new situation, new “friends”, seeing things I’ve never seen before, and sucking up to the frustration of doing things that seem to make  no sense at all, has been the most humbling experience anyone can go through.

Despite all these, I consider myself blessed to be surrounded by the fine people that make up 5 West… The “Flash”, who zips through work like (you guessed it) a flash, “Terrific” CNAs and nurses that always lend a helping hand, “Dan the Man” who has been most helpful in any situation, “Hot Rod” and “Nikon Joe” I call the dynamic duo, with 5 West’s “Crowning Glory” who leadership and tenacity I admire. “Angel” who livens things up, and not to mention “Sarah Lee” who you can depend on. Cheryl (our fairly new addition) who’s kindness and gentle nature just complements the 5 West team (we have to find her a name), “Kenny G” and “Tony the Tiger”, dependability as solid as a rock… Danny our director, who I would say has done a lot of good for the unit, and the rest of the staff, too numerous to mention, but nevertheless, makes a big difference to 5 West.

You are the people that I am honored to be around with, the people who have in a way, “lifted” me up to a higher vantage point… the people who, through your expertise and experience, have broadened my horizon, and opened up the world in a whole different light, and this is something not a lot of people are privileged to experience. Although we have many differences, we are still 5 West, and I’m proud to be part of this awesome team, and together… sky’s the limit.

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Balut day, it’s a celebration! August 23, 2006

Posted by 5 Wester in General Announcements.
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A 5 West staffer sent pictures of BALUT Day… the day after OPUS Day.

I suppose after the launching of the space shuttle of medical records documentation (also known as OPUS) it was time to celebrate a successful lift off. These brave men and women have gone where few have gone before (at least in their lifetime)… the sampling of one of the world’s finest delicacies…BALUT!

BALUT is a Filipino word that roughly translates to mean “wrapped”, as in “balut sa puti” (wrapped in white), “balut sa bakal” (wrapped in iron), or “balut na balut” (“wrapped really good” or “tightly wrapped”). Supot, is also another term that translates to “wrapped” but is less marketable… don’t ask. 🙂

Although popular among Filipinos, this delicacy was known to be introduced by Chinese traders in the Philippines. It is believed to be an aphrodisiac and considered to be a high-protein, hearty snack, as most old folks say, “pampatigas ng tuhod” (strengthens the knees…so it doesn’t buckle up on you). You will find these in some Asian markets today.

What is BALUT exactly? Just ask your Filipino friends or co-workers, or go online and search for “BALUT“. This was actually featured on that popular TV show “Fear Factor“. It’s not as bad as it sounds…it tastes like chicken… or duck?

Anyway, whatever it is, it’s sure to capture one’s imagination. Unlike the launching of OPUS, I guess this thing is a bit easier to swallow. But then again, like anything else, it grows on you.

Balut anyone?

Go Live with a BANG! August 16, 2006

Posted by 5 Wester in OPUS Clindoc Doc!.
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The ACME Computamer (Now available in stores for only $19.95+tax+s/h)

Originally uploaded by pamin21. (Sometimes, you just feel like a nut!)

What can I say? We survived that one!

What a rough night indeed! Frustrations and emotions ran high and at the end, we just had to take a deep breath and hold! In the meantime, I hope you enjoy bathroom poetry…

OPUS Go Live!
by Little EJ

Twas the night OPUS went live, and all through the house,
Everybody was stirring, all clicking the mouse,
Eyes glued to the screen, with silence so haunting,
With deep concentration, on tasks that’s so daunting.

Assessments done easy, with paper so breezy,
Took much of our time, our breaths all turned wheezy,
The five-minute task on paper, now twenty,
Computers so fast, makes us all work slowly.

Less patients to care for, five patients to one,
You’d think everybody, was just having fun,
The laptops our sixth, sixth patient that is,
Got all our attention, and what did we miss?

The pain pill, the Foley, the patient with chole,
The antibiotic, the narc count, the IV,
All else had to wait, for a minute or two,
Oh boy, it was good that nobody turned blue!

Alas I got done, in forty five minutes,
My charting, assessments and all that went in it,
But I’m not rejoicing just yet all because,
Had four more to go, we all had to pause…

For coffee and tea, too bad no balut!
Our eyes have grown weary, we don’t give a hoot!
All faces with smiles, all turned upside down,
Hold on, there is hope, so don’t you dare frown.

The laughter you hear is all too deceiving,
It’s not out of joy, frustrations are heaving,
Was this just too fast, we’re all ill-prepared,
But all is not lost, some wisdom is shared…

This night was a lesson, on implementation,
You don’t expect things to go in perfection,
But with careful planning and mindful brainstorming,
It would have been better, and pleasantly sailing.

What we could have done, was have a dry run,
RNs, CNAs, Clerks under the sun,
To test out the system for one day or two,
And measure performance, adjustments to do.

Adapting the system should be towards us,
And not us adapting to its whims or fuzz,
The power of software is when it is simple,
All its complications has grown me a pimple!

Consultations done, should be from the floor,
The RNs, CNAs, Wark clerks and what more?
It should have been part of this wonderful planning,
Insights from nurses that do some programming!

As always we’re tough, no matter the weather,
Knowledge is good, experience is better,
And what we have learned from tonight we will take,
Into the future, our jobs are at stake!

More on this blessed event, coming up soon…

August 15 is coming… R U Ready? August 12, 2006

Posted by 5 Wester in OPUS Clindoc Doc!.
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Ah, yes! Today’s the 12th, 3 more days till we go live and already the hype has started to build up. You may have noticed those laptops on wheels that look like small bassinets signaling the arrival of our new babies. Not to mention those pop-up screens you see on the desktops announcing the number of days left (sort of countdown till the shuttle lifts off) till everything goes haywire.

I suppose for MMC, this will be the dawn of a new era where technology finally hits and we’ll have to adapt to rapid changes. It’s about time and finally, it has arrived. Do I dare say that we’re finally seeing the light of day?

Now we have the convenience of electronic documentation, which means, lesser papercuts and fumbling for admission packets and forms that seem to be illusive (I though I saw that surgical check list here last week, where did it go?). And thanks to the undercarriage storage bins, we don’t have to punch holes in plastic bags so we can carry our medications around during med pass (although we still have to shop for meds in the Pyxis) it makes work flow better and efficiently. Overall, this is good… very good indeed! Imagine, you don’t have to deal with that pesky JCHACO checklist since the system would be able to do the chart audits automatically.

Soon, we can attach other useful peripheral devices to our mobile workstations such as (and not limited to):

  • Vital signs machine which automatically records your vitals the moment you take them, including O2 sats! WOW!
  • Digital cameras, so you can document wounds and take photographs when needed without having to wait for hours for the Housesuper to be available to release that prized polaroid.
  • Bladder scanners and dopplers and the like
  • EKG and EEGs
  • etc, etc… the list goes on and on…

You might say, “Dream on 5 Wester… dream on!” and you’re right on that! There are things coming down the pipeline that we never even imagined 5-10 years ago. Now, there are here. So don’t be surprised if you see some paper sticking out of my back… I’m just receiving a fax, that’s all! 🙂

I’m a Wireless Wonder! August 5, 2006

Posted by 5 Wester in On Communication.
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Spectralinks

Did you remember when these wireless communication devices were first introduced to the floor? I believe it was around late January/early February 2006 when MMC decided to go “high tech”.

Like with all new technology, this was met with both joy, and pain, depending on who you talk to. I suppose the main reason we had to have these is for ease of communication (not just because our competitor Doctor’s Hospital had them first).

Good as the intentions were, I don’t quite remember if there were any inservice meetings conducted to introduce these wonderful wireless wonders. Just like all new development on the unit, we had to discover this ourselves, as in, “Wow!… new phones… kewl! How do we use them?”.

Eventually, after the excitement has worn off (or not at all), we tend to go back to our usual patterns, i.e., paging over the intercom, walking around to find the nurse, etc… etc… back to our old habits of communication, the good old yell from across the hall… “Yo! You got a call at the nurses station!”. Nothing wrong with that, cavemen has used this for years… and it’s quite effective (just kidding :), good you’re still awake).

When I asked our former director how we should go about using these devices, she just looked at me like I was from another planet. I may be wrong, but it would seem like we did not have any procedure in place to incorporate these wireless wonders. Now I’m sure MMC would want to have a return on their investment, and therefore, we do need to utilize these devices properly.

Just think about the number of hours of time saved if we were able to use these devices to its full potential. Not to mention the quality of care (SERVICE EXCELLENCE… hint, hint) we can actually provide our patients by providing them a quiet environment (no overhead or public paging), faster response to doctors returning calls, and most of all, easier communication between staff. In fact, studies have shown that nursing units with superior communication systems can save more than 700 hours of time between having to go back and forth to the phone to answer calls, and even lessen calls put on hold. Now if that’s not productivity, I don’t know what else is!

Case and point: “The MD that couldn’t wait”

After receiving report at 1930 I was anticipating the surgeon on consult to return call. Surgical consult was ordered for a patient that needed a 3-lumen central line placed to start chemo. I holstered one of these wireless communication devices and strapped it around my waist (I’m surprised it had something to hold on to). I wrote my call number on the board under my name, and like a true Texan cowboy, rode off into the sunset to make my rounds.

A few minutes later I hear this page… “5 Wester state location, MD on hold”. Gliding over to the nurses’ station I get to the phone and “bzzzzzzzz”, dial tone… he had hung up. I put a page via answering service, and continued to do my rounds.

During med pass, I hear the same page “5 Wester state location, MD on hold”. Walking to the nurses’ station (in less than 10 sec) I pick up the phone and “bzzzzzzzz”, same response… he hung up. Paged again and waited… you get the point.

As you can see, the amount of time wasted and the delay in notifying the MD is substantial. This game of phone tag could have been prevented if we had a clear system in place to incorporate these communication devices into our work flow.

But how? How do you think should we go about this? Let us know what you think.

I’ll share the rest in the next episode of “I’m a Wireless Wonder” (because I wonder how we can do this more efficiently ;)).

SERVICE EXCELLENCE in a bottle! August 3, 2006

Posted by 5 Wester in General Announcements, Observation Station, On Service Excellence, Query Yoki!.
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As I settled in for the night, I decided to have me a peanut butter and jelly sandwich. YUM!

What you are looking at is a picture of America’s favorite bread spread, that creamy goodness that sticks to the roof of your mouth that tastes uncunningly like peanuts. Unfortunately, my jar of peanut butter isn’t as full as the one you’re looking at right now, so naturally, I had to use my 2 cents.

Judging from the volume of peanut butter I had left (about 0.5 oz, not enough to fill my tablespoon), I did some scientific calculations that would allow me to cover a 5-square-inch area of toast (about 0.02 oz of peanut butter per square inch). When I was done, I successfully covered that piece of bread with such a thin layer it looked so anemic I wanted to give it a blood transfusion.

While I enjoyed this piece of bread with a hint of peanut butter, it got me thinking. This is kinda like working a 12-hour shift with 4 RNs, 2 CNAs, a census of 28 patients, and 4 ER admissions all waiting for a bed at 5 West. Of course these 4 pending ER admissions aren’t waiting for a bed, what they’re really waiting for is an RN to take them in. At 7 patient’s a piece, we’d like to think we’re capped. But sometimes, we are called for to do the heroic thing… bite off more than we can chew and swallow. Sure, no problem, I can take all 3 admissions… what do we need to prove anyway?

There is a fine line between RN supply and demand that we are dealing with every single day and this balancing act can cost us (really the hospital for that matter) thousands of dollars if not done right. On one side, we want to take in as many patients as we can, after all, this is our bread and butter. More patients mean increased census, which translates to more money (hopefully they have insurance) and more money means profit. The bottom line…how to get more for less. On the other hand, more patients mean more RNs/CNAs needed, which, by the way things are going, seem to be in short supply. Such a short supply prompted the administration to come up with that new and confusing RN incentive program. If we can’t keep or RN/CNA census up, we can’t keep our patient census up.

What does this have to do with peanut butter?

Imagine you going in a gourmet sandwich shop and ordering your favorite “Peanut Butter and Jelly Sandwich Delight“…$9.99 + tax. The waiter hands you your order and you take a bite, anticipating that rich creamy nutty flavor to hit your tastebuds.

As you sink your teeth in, you discovered that the sandwich chef had allocated 0.02 oz of peanut butter per square inch of bread. What would you do?

I’d imagine you’d call your waiter and ask him… “Is this a joke? You call this a peanut butter jelly delight? What kind of quality is this?”. Then he answers you with, “Oh, we’re trying to save money. We figured that if we can spread the peanut butter really thin, we can actually increase our profit margins by 20% since we don’t have to use more peanut butter than is actually needed and the customer still tastes the peanuts anyway!”. How would you react to that? “Brovo! Good job, this is brilliant! Why did I not think of this?” Of course not! You’d say something like, “This is cheating! I want my money back! You’re making a profit on my expense!”

Of course this kinda thing does not happen on the floor. It’s not like we’re spread thin everyday. But I’m sure you’ve experience this more than once before. You know what I mean… those days you have only 1 CNA scheduled when the census calls for 2 or 3. Those days when you have 3 RNs scheduled when the census calls for 4 or 5. And those days when you have 4 RNs, 2 CNAs, 28 patient census, and 4 pending ER admissions, and they want to cap you at 8 patient’s a piece. Of course in extreme times of crisis spreading ourselves thin is a matter of sacrifice than choice. But what is really at steak when we do this, especially when asked to 3 admissions when the resources are not available?

Just like peanut butter on that piece of toast, the quality of care and attention you can give dramatically diminishes when you have to spread 0.02 oz per square inch. Of course they would argue that the patient care risk may be minimal, but then who knows this for sure? Do we have a patient acuity calculator to ensure that our patients are getting enough of that SERVICE EXCELLENCE good stuff? How much time can we and are we spending at the bedside with our patients, such as introducing ourselves, talking to them, making them feel comfortable, and putting them at ease? Are we keeping enough staff on hand so we can be prepared for that 4 pending ER admissions regardless if there are patients in the ER or not? Are we blaming the “competition” more than finding ways to retain and train our valued RNs and CNAs?

What sayest thou oh peanut butter connoisseur?